Author

Date of Award

2-2018

Degree Name

MS in Nutrition

Department

Food Science and Nutrition

Advisor

Dr. Peggy Callaghan Papathakis, PhD, RD

Abstract

Background: Adolescent childbearing and maternal malnutrition are common in low- and middle-income countries and are associated with increased risk for poor maternal and infant outcomes. Adolescent pregnancy compounded with moderate malnutrition exacerbates outcomes common to both individually. Supplementary foods may be a way to improve outcomes in malnourished adolescent pregnant women.

Objective: To retrospectively assess maternal and infant outcomes in moderately malnourished pregnant young adolescents (16-17 YO), older adolescents (18-19 YO), and adults (≥20 YO) in response to one of three nutritional interventions and in a pooled treatment group analysis, and to assess differences in infant outcomes by infant gender.

Methods: Height, weight, MUAC, and FH were measured in pregnant women with MUAC >20.6 cm and < 23.0 cm at baseline (N=1828) every 2 weeks over the course of enrollment while receiving either: 1) macro- and micronutrient fortified, peanut-based, ready-to-use supplementary food (RUSF), 2) corn-soy blended flour with a prenatal multiple micronutrient supplement (CSB-UNIMMAP), or 3) corn-soy blended flour with iron and folic acid (CSB-IFA). Each provided approximately double the RDA of most micronutrients, 900 kcal/day and 33-36 g/day protein. Postpartum maternal and infant measurements were taken at delivery, and after 6 and 12 weeks. Maternal age at enrollment variable was transformed from a continuous variable into a categorical variable; young adolescent (16-17 YO), older adolescent (18-19 YO), and adults (≥20 YO). General linear models with normal errors were used to compare: 1. Adolescent maternal and infant outcomes by intervention, 2. Adolescent maternal and infant outcomes by maternal age within each intervention group, 3. Maternal and infant outcomes in a pooled treatment analysis by maternal age, 4. Interaction effects between maternal age and intervention, 5. Infant outcomes by infant gender. If differences between groups were detected, they were tested using the Tukey HSD test (response) or the likelihood ratio-based odds ratios (categorical). Odds ratios were measured using effects likelihood ratio tests via logistic regression. Response variables included in the analyses were BMI and fundal height at enrollment.

Results: There were 297 young adolescents, 582 older adolescents, and 949 adults enrolled. Adolescents enrolled in the study at a younger gestational age than the adult mothers. Upon enrollment, BMI was greater and FH was smaller in the adolescent mothers than adults. At delivery, adolescent mothers had gained less weight on treatment, delivered with a lower final MUAC and FH, had increased odds of delivering extremely prematurely, and the greatest odds for delivering before recovery from malnutrition (MUAC ≥23.0 cm). Infants of young adolescent mothers were inferior anthropometrically to infants of the older mothers and had greatest odds of being underweight and stunted through 12 weeks of age. Young adolescents had the greatest odds for delivering LBW infants compared to the adults. Catch up growth was observed in the infants of older adolescents by 12 weeks of age; however, no catch up was observed for the infants of young adolescents. No one intervention was more helpful than another in determining maternal and infant outcomes of the adolescent mothers, and male infants had greater odds of being underweight and stunted at 6 and 12 weeks of age.

Conclusions: Although adolescents did not appear to have characteristics of more severe clinical malnutrition, such as lower BMI, lower maternal height, and increased rates of HIV at baseline, maternal and infant outcomes were worse for the adolescent mothers compared to the older, more mature mothers. Adolescents gained less weight during pregnancy and delivered smaller infants that were unable to catch up linearly and with weight gain. Pregnant adolescents, particularly young adolescents, are a high-risk population and public health efforts should be made to delay the age of first pregnancy.